治疗白癜风的药 http://pf.39.net/bdfyy/bdfjc/140807/4442971.htmlPrognosticvalueofNT-proBNPformyocardialrecoveryinperipartumcardiomyopathy(PPCM)ClinResCardiolOriginalPaperEarlyRecent,Feb08,./s---z本文由“天纳”临床学术信息人工智能系统自动翻译点击文末“阅读原文”下载本文PDFIntroductionPeripartumcardiomyopathy(PPCM)isanimportantcauseofpregnancy-associatedheartfailureworldwide.Althoughasignificantnumberofwomenrecovertheirleftventricular(LV)functionwithin12?months,someremainwithpersistentlyreducedsystolicfunction.围产期心肌病（PPCM）是妊娠相关性心力衰竭的重要病因。尽管有相当一部分女性在12个月内恢复了左心室功能，但仍有一些女性的收缩功能持续下降。MethodsKnowledgegapsexistonpredictorsofmyocardialrecoveryinPPCM.N-terminalpro-brainnatriureticpeptide(NT-proBNP)istheonlyclinicallyestablishedbiomarkerwithdiagnosticvalueinPPCM.WeaimedtoestablishwhetherNT-proBNPcouldserveasapredictorofLVrecoveryinPPCM,asmeasuredbyLVend-diastolicvolume(LVEDD)andLVejectionfraction(LVEF).在预测PPCM心肌恢复方面存在知识差距。N-末端脑利钠肽前体（NT-proBNP）是临床上唯一具有PPCM诊断价值的生物标志物。通过左室舒张末期容积（LVEDD）和左室射血分数（LVEF）的测定，探讨NT-proBNP能否作为PPCM患者左室恢复的预测指标。ResultsThisstudyof35womenwithPPCM(meanage30.0?±?5.9?years)hadamedianNT-proBNPof.7?pg/ml(IQR.2–.5)atbaseline.Withinthefirstyearoffollow-up,51.4%ofthecohortrecoveredtheirLVdimensions(LVEDD??55?mm)andsystolicfunction(LVEF??50%).WomenwithoutLVrecoverypresentedwithhigherNT-proBNPatbaseline.MultivariableregressionanalysesdemonstratedthatNT-proBNPof?≥??pg/mlatthetimeofdiagnosiswaspredictiveoffailuretorecoverLVEDD(OR0.22,95%CI0.05–0.95,P?=?0.)orLVEF(OR0.20[95%CI0.04–0.89],p?=?0.)atfollow-up.这项研究对35名PPCM女性（平均年龄30.0±5.9岁）进行了研究，基线检查时NT-proBNP中位数为.7pg/ml（IQR.2–.5）。在随访的第一年内，51.4%的患者恢复了左室内径（LVEDD??55mm）和收缩功能（LVEF??50%）。无左室功能恢复的妇女在基线检查时NT-proBNP较高。多变量回归分析显示，诊断时NT-proBNP≥pg/ml可预测随访时LVEDD（OR0.22，95%CI0.05–0.95，P?=?0.）或LVEF（OR0.20[95%CI0.04–0.89]，P?=?0.）恢复失败。ConclusionsWehavedemonstratedthatNT-proBNPhasaprognosticvalueinpredictingLVrecoveryofpatientswithPPCM.PatientswithNT-proBNPof?≥??pg/mlwerelesslikelytoshowanyimprovementinLVEForLVEDD.OurfindingshaveimplicationsforclinicalpracticeaspatientswithhigherNT-proBNPmightrequiremoreaggressivetherapyandmoreintensivefollow-up.Point-of-careNT-proBNPfordiagnosisandriskstratificationwarrantsfurtherinvestigation.我们已经证实NT-proBNP对预测PPCM患者的左室恢复具有预后价值。NT-proBNP≥pg/ml的患者不太可能出现LVEF或LVEDD的任何改善。我们的发现对临床实践有一定的指导意义，因为NT-proBNP较高的患者可能需要更积极的治疗和更深入的随访。用于诊断和危险分层的NT-proBNP护理点值得进一步研究。IntroductionPeripartumcardiomyopathy(PPCM)isanimportantcauseofpregnancy-associatedheartfailureandoccursinwomentowardstheendofpregnancyorwithinthefirstfivemonthsafterdelivery[1,2].Althoughupto46%ofpatientswithPPCMrecovertheirleftventricular(LV)functionwithin6?months,23%remainwithseverelyimpairedLVsystolicfunctionanddevelopchronicheartfailure[3].围产期心肌病（PPCM）是妊娠相关心力衰竭的一个重要原因，发生在妊娠末期或分娩后的前5个月内[1，2]。尽管高达46%的PPCM患者在6个月内恢复了左心室（LV）功能，但仍有23%的患者左心室收缩功能严重受损，并发展为慢性心力衰竭[3]。DespiterecentadvancesinthemanagementofPPCM,predictorsofmyocardialrecoveryremainpoorlyunderstood.PreviousbaselineclinicalfactorsthathavebeenshowntoinfluenceLVrecoveryincludeLVEF,[4,5,6]LVdimensions,[5,7,8]presenceofLVthrombus,[7]rightventricular(RV)systolicdysfunction[9]andAfrican-Americanethnicity[5,7,10,11].IdentificationofpredictorsofLVrecoverycouldhelptoriskstratifypatientsatthetimeofPPCMdiagnosis,andidentifythosepatientsthatmaybenefitfrommoreintensivetherapyandfollow-up.尽管近年来PPCM的治疗取得了进展，但对心肌恢复的预测因素仍知之甚少。以前的基线临床因素已被证明影响左室恢复，包括左室射血分数，[4,5,6]左室尺寸，[5,7,8]左室血栓的存在，[7]右心室（RV）收缩功能障碍[9]和非裔美国人种族[5,7,10,11]。确定LV恢复的预测因素有助于在PPCM诊断时对患者进行风险分层，并确定那些可能受益于强化治疗和随访的患者。B-typenatriureticpeptide(BNP)anditsprohormone,N-terminalB-typenatriureticpeptide(NT-proBNP),arereleasedinresponsetocardiacwallstress,[12,13]andareimportantbiomarkersinthediagnosisofheartfailure[14].However,theroleofnatriureticpeptidesispredominantlytoruleoutheartfailure.PreviousstudieshaveshownthatNT-proBNPiselevatedatthetimeofdiagnosisofPPCM[15,16]andadiagnosisofPPCMisunlikelyifapatientpresentswithBNP???pg/mlorNT-proBNP???pg/ml[2].Furthermore,NT-proBNPisusefulindifferentiatinghealthypostpartumwomenfromthosewithPPCMorpre-eclampsia[6,15,17].B型利钠肽（BNP）及其前激素，N-末端B型利钠肽（NT-proBNP）在心壁应激时释放[12，13]，是诊断心力衰竭的重要生物标志物[14]。然而，利钠肽的作用主要是排除心力衰竭。先前的研究表明，NT-proBNP在诊断为PPCM时升高[15，16]，如果患者出现BNPpg/ml或NT-proBNPpg/ml，则不太可能诊断为PPCM[2]。此外，NT-proBNP有助于区分健康的产后妇女与PPCM或先兆子痫患者[6，15，17]。WhileelevatedNT-proBNPlevelshavebeenshowntopredictmortalityandcardiovasculareventsinpatientswithheartfailure,evenamongstthosewhowereasymptomatic,[18]littleisknownabouttheprognosticvalueofNT-proBNPamongstpatientswithPPCM.Inthisstudy,weaimedtoassesswhetherNT-proBNPcouldserveaspredictorofLVrecoveryinPPCM.尽管NT-proBNP水平升高已被证明可以预测心力衰竭患者的死亡率和心血管事件，即使在那些无症状的患者中，[18]对于NT-proBNP在PPCM患者中的预后价值知之甚少。在这项研究中，我们旨在评估NT-proBNP是否可以作为预测PPCM左室恢复的指标。MethodsStudydesignandrecruitmentWomenwithPPCM,seenatthededicatedCardiomyopathyClinicatGrooteSchuurHospital,wererecruitedbetweenand.Patientswerereferredfromprimaryorsecondarycarefacilitiesorwithinthetertiary/quaternaryhospital,andassessedbyateamofcardiologistsandheartfailurespecialists.年至年间，医院专门的心肌病门诊就诊的PPCM女性被招募。患者从一级或二级医疗机构或三级/医院转诊，并由一组心脏病专家和心力衰竭专家进行评估。Inclusioncriteriaincluded:(1)primarydiagnosisofPPCM,i.e.documentedclinicalevidenceofLVsystolicdysfunctiontowardstheendofpregnancyorduringthefirstfivemonthspostpartum;(2)nootheridentifiablecausesofheartfailure;(3)LVEF?≤?45%onpresentationconfirmedbytransthoracicechocardiography.Exclusioncriteriawere:(1)patientunabletogiveinformedconsent;(2)otheridentifiablecausesofheartfailure;and(3)patientsyoungerthan18years.纳入标准包括：（1）PPCM的初步诊断，即妊娠末期或产后前5个月左室收缩功能障碍的临床证据；（2）无其他可识别的心力衰竭原因；（3）经胸超声心动图证实的LVEF≤?45%。排除标准为：（1）不能给予知情同意的患者；（2）其他可确定的心力衰竭原因；（3）年龄小于18岁的患者。ThisstudywasapprovedbytheUniversityofCapeTown’sFacultyofHealthSciencesHumanResearchEthicsCommittee(HRECrefnoR/),and
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